Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity

Dashwood, Michael R.; Savage, Kay; Tsui, Janice; Dooley, A; Shaw, Sidney; Alfonso, María Soledad Fernández; Bodin, Lennart; Souza, Domingos

doi:10.1016/j.jtcvs.2008.11.060

Cited by 78 publications

(84 citation statements)

References 34 publications

(39 reference statements)

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“…Morphometric analysis of the vessel wall and ultrastructural analysis using electron microscopy revealed a significant reduction in the total area of vasa vasorum in the media (P=0.007) and adventitia (P=0.014) of CT veins. Dashwood et al [6] conducted a cohort study where in both techniques a portion of the vein was distended. They studied 26 patients analysing the distension-induced morphological damage and eNOS expression.…”

Section: Resultsmentioning

confidence: 99%

Does a 'no-touch' technique result in better vein patency?

Sepehripour

Jarral

Shipolini

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. A total of 405 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the ultrastructural and mechanical properties of the endothelium and vessel walls of the two harvesting techniques; the protein and enzymatic expression and activity observed; the early atherosclerotic changes detected; and the overall patency of the grafts during short- and long-term angiographical follow-up. Three small prospectively randomised studies compared the patency of grafts harvested using the two techniques and found significant improvements in graft patency using the no-touch harvesting technique in comparison to both the conventional technique and more importantly comparable to the left internal thoracic artery (LITA) patency. The most favourable difference was that of graft patency after 8.5 years of follow-up [90% vs. 76% (P = 0.01), LITA patency 90%], and incidence of graft stenosis [11% vs. 25% (P = 0.006)]. These findings were supported by the demonstrated improvements in the cellular integrity of the vessels and the reduction in the mechanisms leading to graft failure seen in the no-touch harvested SV grafts. These morphological and cellular analyses were carried by five small comparative studies, demonstrating improved endothelial integrity and reduced injury, decelerated atherosclerotic processes, intact adventitial collagen layers, increase in the total area of vasa vasorum, elevated endothelial nitric oxide synthase expression and activity, and increased peri-vascular leptin levels and activity. We conclude that there are clear enhancements in vessel wall properties at a cellular level and angiographical evidence of superior graft patency when the no-touch SV harvesting technique is employed.

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Section: Resultsmentioning

confidence: 99%

Does a 'no-touch' technique result in better vein patency?

Sepehripour

Jarral

Shipolini

et al. 2011

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…As a method to avoid over-handling of the vein and increased distention pressures a pedicle technique was developed and named the "no touch" technique. It was thought that veins procured in this manner would eliminate the need for conduit distention and its associated morbidities since the perivascular adipose tissue surrounding the vein was left intact [9]. It had been shown that this surrounding tissue in internal thoracic mammary arteries provided a vasodilatory effect with less arterial conduit vasospasm.…”

Section: How Vein Harvesting Methods Can Affect Patency Ratesmentioning

confidence: 99%

“…It had been shown that this surrounding tissue in internal thoracic mammary arteries provided a vasodilatory effect with less arterial conduit vasospasm. Increased patency rates were demonstrated with the "no touch" technique compared to the conventional open technique [9]. 1997 began a new era in coronary artery bypass grafting with the use of EVH to harvest the saphenous vein.…”

Section: How Vein Harvesting Methods Can Affect Patency Ratesmentioning

confidence: 99%

Saphenous Vein Conduit in Coronary Artery Bypass Surgery — Patency Rates and Proposed Mechanisms for Failure

Khaleel¹,

Dorheim²,

Duryee³

et al. 2013

Artery Bypass

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“…In the "in touch' technique of removal of the saphenous vein developed by Dashwood et al [8], maintaining a thick pedicle of the saphenous vein, mimicking the classic way of dissecting the ITA, was accompanied by greater saphenous vein patency, perhaps because of greater local release of nitric oxide. The advantage of thick pedicle is not shown in the ITA, in which there is migration in order to perform the dissection using the skeletonized technique.…”

Section: See Also Original Article On Pages 617-623mentioning

confidence: 99%

Dissecção da artéria torácica interna de modo esqueletizado

Murad¹

2011

Rev Bras Cir Cardiovasc

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Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity

Cited by 78 publications

References 34 publications

Does a 'no-touch' technique result in better vein patency?

Does a 'no-touch' technique result in better vein patency?

Saphenous Vein Conduit in Coronary Artery Bypass Surgery — Patency Rates and Proposed Mechanisms for Failure

Dissecção da artéria torácica interna de modo esqueletizado

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